Facet and Medial Branch Blocks
What is the facet joint?
Facet joints are the small joints at the back of the spine which support and aid in the rotation and bending of the back. Your joints can become irritated and inflamed from injury or arthritis. Facet joint pain is often experienced when bending backwards or twisting your back or torso. If the facet joints are irritated in your lower back or lumbar region, the pain may radiate from the spine into the buttocks, hip and back of the thigh. The pain frequently stops at the knee. If the facet joints are irritated in your upper back or cervical region, the pain may radiate from the spine into your neck, head and shoulders.
What is a Facet Joint Injection? The facet joint block is the injection of local anesthetic and steroid medication into the facet joint. The injection is done to decrease the inflammation and irritation, which in turn decreases the pain. The local anesthetic or numbing medication will wear off approximately six hours after the injection. Your pain may briefly return before the steroid medication takes affect. This does not mean the block did not work. The steroid or anti-inflammatory medication may not start working for 24 to 72 hours. Sometimes it can take up to one week for the steroid to work or take affect. This block can last anywhere from weeks to months. If you get good, lasting pain relief from these injections the block may be repeated. If you receive only short term pain relief, medial branch nerve blocks may be needed.
What is a Medial Branch Block? A medial branch block is similar to the facet joint injection, except the medication is placed outside the joint space near the medial branch nerve. This nerve supplies the facet joint. This procedure is often done twice, several days apart. The first time the medial branch block is performed, a long acting local anesthetic will be injected in this space to block the medial branch nerve. The second time the procedure is performed, a shorter acting local anesthetic is used. The Medial Branch Blocks are diagnostic injections only. They are used to determine the cause of your pain. The Medial Branch Block will only provide short term pain relief. If you receive relief from your pain, a more permanent procedure (Radiofrequency Ablation) will be discussed with you.
How will the procedure(s) be performed? You will arrive at the George Isaac Center approximately 45 minutes before your scheduled procedure. The nurses will complete the necessary medical forms, take your vital signs and start an IV. The IV will be used during the procedure to give you medication to relax you and control your discomfort. It is necessary that you remain awake during the procedure so that you can tell the physician if you have any unusual symptoms or discomfort. You will be transported by cart to a special room and positioned on your stomach on a special x-ray table. The skin on your back will be cleaned with antiseptic cleanser and then draped with sterile towels. Under fluoroscopy, a special X-ray machine, the doctor will determine the exact location(s) that need to be blocked. The area(s) where the needle(s) will be inserted is injected with local anesthetic (numbing medication similar to what your dentist uses). The needle is then inserted under fluoroscopy, which allows the doctor to see your spine and the needle as it moves into the facet joint or space next to the nerve branch. Once the needle is in the correct position the medication is injected. Your skin will be cleansed and band-aid dressings applied. You may remove the band-aids the following day. You will then be transferred by cart back to the recovery area where you will be monitored closely for the next 30-45 minutes. You will be given specific written discharge instructions and allowed to leave by wheelchair with your ride once the physician authorized your discharge.
What are the complications of these procedures? There is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Short term side effects may occur. These can be the spread of local anesthetic to nearby nerves, which may result in weakness or numbness that can last for several hours. You may experience increased pain for several days after the injection, including localized pain at the injection site. If you are diabetic, your blood sugars may be elevated short term. Individuals that are prone to fluid retention may have increased fluid retention for 1-2 weeks.
What should I do after the procedure?
You will be given a discharge instruction sheet prior to leaving the recovery area. This sheet provides you with detailed information regarding complications, side effects, restrictions and when to contact the Pain Medicine Center or seek immediate treatment at the Emergency Room. A follow up appointment will also be scheduled for you prior to discharge from the Recovery Room.
There are NO GUARANTEES that this injection, or any other type of treatment, will relieve your pain.